Rachel Fox

Future of Nursing: Institute of Medicine Assignment

1) Nurses should practice to the full extent of their education and training.
This first key message set forth by the Institute of Medicine is particularly
important. Nurses are the largest part of the healthcare team, by number, and have the
ability to have the greatest influence on healthcare practices. As a Registered Nurse, we
are capable of working in all areas of healthcare, numerous different settings, hours of
work, differing roles, and capable of frequent change. My enrollment into the BSN
program at Ferris State represents me taking the first step to furthering my education,
and thus opening up even greater opportunity for my career and ability to help others. I
am currently weighing the options of pursuing anesthesia school versus a different
advanced practice degree after my BSN. Nursing is a career full of people who are
confident, caring, compassionate individuals. If nurses were allowed more autonomy in
their practice, it could reduce the workload of other disciplines and allow the nurse to
feel a greater sense of worth in their role.
One example that comes to mind from my practice is the use of Advanced Triage
Protocols. During particularly high-volume times with long waits in the waiting room, as
the ER triage nurse we have protocols set in place to help move the process along. For
example, a patient signs in with trouble breathing. We have been trusted, as the
experienced triage nurse, to determine the cause of dyspnea as respiratory or cardiac in
origin and begin a plan of care based on our assessment. There are protocols to start
an IV, for which labs to obtain, to do an EKG, order a chest 1 view, and order other
radiology as indicated (CT chest for possible PE, Doppler US for risk of DVT, SVN
treatments as needed). The nurse then has the ability to identify potential medication
intervention and discuss with the ER physician. Examples include: Lasix and nitro for
CHF, and breathing treatments coordinated with respiratory therapy. When I worked in
the ICU, there were protocols for things such as electrolyte replacement that allowed
the nurse to order and supplement as indicated. There are many other opportunities to
increase this type of autonomy for nurses.
2) Nurses should achieve higher levels of education and training through an
improved education system that allows seamless academic progression.
The current facility I work at does not require nurses to hold a BSN. However, if
the nurse is not BSN prepared, staff nursing is about the only opportunity available. Any
member of management or any advanced practice role holds at least a masters degree
in their line of work. I think an important aspect of this second message is the phrase
seamless academic progression. I feel my transition from ADN to BSN is anything but
seamless. I hold my ADN Baker College in Flint, a private college. My undergraduate
education was focused, and accelerated, and I feel, prepared me very well for my
current role as a nurse. However, as I begin my second degree at a university, a good
deal of my credits are lost during the transfer process. Also, many of the pre-requisites
required differ, leaving me to take additional classes that are required by the university
for graduation, but have no direct effect on my nursing practice. If there were
improvements made to the education system to make the requirements more equivalent
this would ease the process when advancing education.

Rachel Fox

3) Nurses should be full partners with physicians and other healthcare

professional in redesigning healthcare in the United States.
This third message is, in my opinion, another top priority. Nurses are the
caregivers that are at the front lines doing all the hands on care and monitoring of the
patient. I think it is important for nurses to be involved in hospital wide meetings for
policy and product changes. A recent example Ive experienced took place on the PICC
line team I am part of. For nearly two years now we have been using a biopatch and
sterile dressing on PICC lines, midlines and mediports. We also have a nearly 0%
hospital acquired line infection on our PICCs. The hospital has now made the
uneducated decision to go back to a chlorhexadine gel-patch dressing instead of the
biopatch because of cost effectiveness. However, these dressings had a nearly 5%
higher line infection rate at our hospital and are more difficult to remove from the line
and skin because they are so sticky. The decision was made by people who are not
directly involved in the care of the patient. Additionally, the cost the hospital will incur for
treating the hospital acquired line infection that we gave them will certainly outweigh
the few cents being saved on the difference in supplies. Im sure many nurses have
numerous examples similar to these.
Also, I am involved in a committee called UBAT, Unit Based Action Team. We
are a group that meets once monthly to discuss changes, problems, policies, and
procedures within the unit that require review or education. We also meet with other
units UBAT committees in the hospital to discuss problems and ease transitioning
between units.
I am a firm believer that if nurses were involved deeper in the decision making
process of hospitals and healthcare standards in general, that healthcare could be
improved; not only for cost, but also effectiveness and safety. I also think that nurses in
general possess a desire to being more involved and valued in their role. Being involved
in decisions and planning would allow ease in their job, and feel a greater sense of
appreciation.
4) Effective workforce planning and policy making require better data collection
and an improved information infrastructure.
This message is important to ensure there is a consistent influx of educated,
compassionate, and motivated nurses coming forth to care for patients to replace those
that leave. I remember learning in nursing school about the prediction of a large number
of nurses that will be retiring in the next 5-10 years and the impact this will have on
healthcare. I think at the hospital level, this could be eased by placing a large emphasis
on recruitment and retention. Also, a strong emphasis should be placed on the
orientation process to breed competent, safe, educated nurses. These two focuses can
easily be impacted and accomplished by the BSN nurse. Also, in increased awareness
of the flexibility and large opportunity of nursing could be spread the younger generation
who may be influenced to choose nursing as career.